Electrophysiology Practice During COVID-19 Pandemic: A New York Tertiary Hospital Experience

Abstract

As hospitals became overwhelmed during the Covid-19 pandemic in March-May in New York, Cardiology and Electrophysiology (EP) departments rapidly developed protocols for case selection as well modifying the practice of managing the cases. This process involved applying the American Heart Association (AHA) and Heart Rhythm Society (HRS) Guidelines for triaging the cases based on acuity, postponing the elective cases and modifying the way Cardiac Implantable Electronic Devices (CIEDs) interrogation. Procedural revisions were necessary for the workflow in the electrophysiology laboratory and that involved modifying the EP suite to accommodate a Covid procedure room, a decontamination equipment area and repurposed room for recovery in the context of personnel (EP attendings and fellows) and the main recovery area being diverted to Covid-19 ICU. The anesthesiology team had an integral and essential role in this process. This article describes in detail the collaborative planning, preparation and implementation of electrophysiology practice at one of the major tertiary centers in New York. It describes the type of EP procedures performed during mid-March to mid-May at this center, the decision process in case selection, anesthetic management and outcomes and the comparison with the previous year. Recommendations by the AHA/HRS as well as American Society of Anesthesiology (ASA) were considered in the multidisciplinary collaborative approach to patient care and personnel safety.

Effect of COVID-19 on cardiac electrophysiology practice: a systematic review of literature

“…Of these, 45 studies were excluded based on the inclusion criteria. A total of 23 studies qualified for the final qualitative analysis 4 , 10 – 31 . A total of 4 studies were from the United States of America, 14 from Europe, and 1 from Pakistan, Oman, Iran, Japan, and New Zealand.…”

“…The most common reason stated for the observed decline in EP procedures was the cancellation and postponement of nonurgent elective cases in the hospitals (15/23 studies, 65.2%). Seven (30.4%) studies reported their hospitals/centers being converted into COVID-19 referral centers 4 , 10 , 14 – 16 , 18 , 19 . Six (26.1%) studies reported an inverse relationship between rising COVID-19 cases and the declining rates of EP procedures 11 , 17 – 20 , 27 .…”

“…Six (26.1%) studies reported an inverse relationship between rising COVID-19 cases and the declining rates of EP procedures 11 , 17 – 20 , 27 . Organizational restructuring in response to the pandemic and the issuance of new guidelines for EP procedures were reported in nine (39.1%) studies 4 , 10 , 14 – 17 , 19 , 29 , 30 .…”

“…An estimated 19 124 EP procedures were carried out during the COVID-19 pandemic in all studies compared to 24 916 EP procedures carried out before the pandemic. Nineteen studies reported pre-COVID-19 data on EP procedures being carried out in tertiary level care centers 4 , 12 – 18 , 20 , 22 – 31 . Only one study reported data on postCOVID EP procedure volumes 15 .…”

“…At the start, the main initiative for these guidelines was to minimize the exposure of healthcare workers to COVID-19 3 . Second, there was a reduction of nonemergency diagnostic and therapeutic procedures to make room for COVID-19 patients and take advantage of the structural and functional capacity of the hospitals 4 . However, as more research was conducted on COVID-19, the nonpulmonary complications came to light, including cardiovascular diseases 5 – 7 .…”